<?php if ( ! defined('ABSPATH')) exit('restricted access');

$options = array();


$options['patient_name'] = array(
								'label'=>__('Patient Name', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'info'=>__('Requesting appointment for', $this->text_domain),
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'trim|required|min_length[3]|max_length[40]',
								'heading'=>__('Patient Information', $this->text_domain));
								
$options['street_address'] = array(
								'label'=>__('Street Address', $this->text_domain),
								'type'=>'input',
								'value'=>'',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required|stripslashes',
								'info'=>__('Provide your streed Address', $this->text_domain));
								
$options['app_city'] = array(
								'label'=>__('City', $this->text_domain),
								'type'=>'input',
								'value'=>'',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required|alpha_space',
								'info'=>__('Provide your City', $this->text_domain));

$options['app_state'] = array(
								'label'=>__('State', $this->text_domain),
								'type'=>'input',
								'value'=>'',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required|alpha_space',
								'info'=>__('Provide Your state', $this->text_domain));
								
$options['app_zip'] = array(
								'label'=>__('Zip Code', $this->text_domain),
								'type'=>'input',
								'value'=>'',
								'std'=>'',
								'attrs'=>array('class'=>'text_shorter regular-text'),
								'validation'=>'required|stripslashes',
								'info'=>__('Provide your streed Address', $this->text_domain));
					
$options['app_dob'] = array(
								'label'=>__('Date of Birth', $this->text_domain),
								'type'=>'timepicker',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text', 'placeholder'=>'0000-00-00'),
								'validation'=>'required',
								);
								
$options['app_gender'] = array(
								'label'=>__('Gender', $this->text_domain),
								'type'=>'radio',
								'value'=>array('male'=>__('Male', $this->text_domain), 'female'=>__('Female', $this->text_domain)),
								'std'=>'male',
								'attrs'=>array('class'=>''),
								'validation'=>'required',
								);

$options['app_name'] = array(
								'label'=>__('Name ( If different from the Patient name )', $this->text_domain),
								'type'=>'input',
								'value'=>'',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'',
								'heading'=> __('Contact Information', $this->text_domain),
								);
								
$options['app_email'] = array(
								'label'=>__('Email Address', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required|valid_email',
								);
									
$options['day_phone'] = array(
								'label'=>__('Daytime Phone', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required',
								);

$options['evening_phone'] = array(
								'label'=>__('Evening Phone', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'required',
								);
								
$options['appointment_date'] = array(
								'label'=>__('Requested Appointment Date', $this->text_domain),
								'type'=>'timepicker',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text', 'placeholder'=>'0000-00-00 00:00:00'),
								'validation'=>'required',
								'heading'=>__('Appointment Information', $this->text_domain)
								);

$options['app_type'] = array(
								'label'=>__('Type of Appointment', $this->text_domain),
								'type'=>'dropdown',
								'value'=>array('child'=> __('Child', $this->text_domain),'friend'=>__('Friend', $this->text_domain),'parent'=>__('Parent', $this->text_domain),'partner'=>__('Partner', $this->text_domain),
												'patient'=>__('Patient', $this->text_domain), 'physician'=>__('Physician', $this->text_domain),	'relative'=>__('Relative', $this->text_domain),'self'=>__('Self', $this->text_domain),
												'sibling'=>__('Sibling', $this->text_domain),'spouse'=>__('Spouse', $this->text_domain),'other'=>__('Other', $this->text_domain)
											),
								'std'=>'',
								'attrs'=>array('class'=>'dropbox'),
								'validation'=>'required',
								);

$options['other_type'] = array(
								'label'=>__('If Other, Requested Specialty ex: Cardiology, Neurology', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'stripslashes',
								);
								
$options['refering_phy'] = array(
								'label'=>__('Reffering Physician ( If Applicable )', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'',
								);
								
$options['phy_address'] = array(
								'label'=>__('Reffering Physician Address', $this->text_domain),
								'type'=>'input',
								'std'=>'',
								'attrs'=>array('class'=>'text regular-text'),
								'validation'=>'stripslashes',
								);
								
if(current_user_role() == 'doctors')
{
	$options['requested_phy'] = array(
								'label'=>__('Requested Physician', $this->text_domain),
								'type'=>'hidden',
								'std'=>get_current_user_id(),
								'attrs'=>array('class'=>'dropbox'),
								'validation'=>'required|is_natural_no_zero',
								);	
}else
{
	$options['requested_phy'] = array(
								'label'=>__('Requested Physician', $this->text_domain),
								'type'=>'dropdown',
								'value'=> $this->doctors_array(),
								'std'=>'',
								'attrs'=>array('class'=>'dropbox'),
								'validation'=>'required||is_natural_no_zero',
								);
}

$options['seen_before'] = array(
								'label'=>__('Have You seen this Physician before?', $this->text_domain),
								'type'=>'radio',
								'value'=>array('yes'=>__('Yes', $this->text_domain), 'no'=>__('No', $this->text_domain)),
								'std'=>'no',
								'attrs'=>array('class'=>''),
								'validation'=>'required|alpha',
								);
								
$options['existing'] = array(
								'label'=>__('Have you ever been a patient at '.get_bloginfo('name').' in past?', $this->text_domain),
								'type'=>'radio',
								'value'=>array('yes'=>__('Yes', $this->text_domain), 'no'=>__('No', $this->text_domain)),
								'std'=>'no',
								'attrs'=>array('class'=>''),
								'validation'=>'required|alpha',
								);
								
$options['description'] = array(
								'label'=>__('Please describe your medical condition and what type of appointment you are requesting. CANCER PATIENTS: What type of cancer do you have?', $this->text_domain),
								'type'=>'textarea',
								'std'=>'',
								'attrs'=>array('class'=>'text '),
								'validation'=>'required|stripslashes',
								);

if(is_user_logged_in() && is_admin())
{
	$options['status'] = array(
									'label'=>__('Status', $this->text_domain),
									'type'=>'dropdown',
									'value'=> array('0'=>__('Pending'), '1'=>__('Accepted'), '2'=>__('Rejected'),),
									'std'=>'',
									'attrs'=>array('class'=>'dropbox'),
									'validation'=>'required',
									);
}